News at Telecare

Across the nation, 60 million adults aren’t receiving adequate primary care, 33% of adults with serious mental illness aren’t receiving any mental health services, and 90% of people with substance use conditions aren’t receiving any care for their substance use.

Yet individuals with co-occurring SMI and substance use are often among the highest utilizers in their systems of care. At Telecare, these co-occurring conditions are very prevalent: 70% of our clients are also dealing with substance use. The majority of these individuals do not recognize that their substance use is affecting their health and wellness, aren’t currently considering treatment, and aren’t considering a change in their use of substances.

In August 2018, Telecare’s Vice President of Operations, David Heffron, and Director of Special Projects - Substance Use Treatment Services (SUTS), Scott Madover, presented at the Substance Use Disorder Statewide Conference put on by the California Department of Health Care Services. We are pleased to share their presentation, “Reaching the Unreachable: Engaging People with SUTS in Pre-Contemplation Phase,” and their ingredients for success below.

Download a PDF of the Presentation

Click the image above to download a pdf of our suts presentation

Reaching the Unreachable: Engaging People with SUTS in Pre-Contemplation Phase

So how do we help people who not yet ready for change? How can improve health and wellness — when a person does not recognize the impact of substance use in their life?

We begin from a place of curiosity, conversation, information, and engagement — for staff and clients — and we cultivate an environment where change might be possible.

As part of Telecare’s Whole Person Care initiative, we developed and launched a curriculum called Co-Occurring Education Groups (COEG). The 16-week curriculum is intended to address the shared challenges providers and systems face: reaching the “unreachable” through respect, engagement, education, and ongoing support.

COEG Basic Framework

Each session in the 16-week curriculum covers a different topic of discussion: from understanding addiction, to recognizing triggers, to reflecting on one's hopes and goals. In some of Telecare’s programs, groups are offered weekly; in others, groups are offered several times a week. Each group is moderated by a trained staff member and takes 60 to 90 minutes to complete. Due to Telecare’s many types of programs, the curriculum was designed to supplement — not replace — the regular clinical services that a program already delivers. Likewise, the curriculum does not contain service-line specific information, therefore, almost any program can use the materials. The groups are open, so new participants can join a group at any time. This flexible drop-in format gives individuals ownership over their future.

Summer is one of the busiest times at Telecare. Our Start-Up Team is currently deployed across California to support the launch of programs designed in partnership with new and existing customers. From May through July, Telecare opened the following programs, and more are coming soon. To explore Telecare’s full list of locations, click here.

Southern California

In May, Telecare's newest crisis residential program, TREEhouse North, opened as part of Orange County Health Care Agency's efforts to expand its network of crisis care. Similar to TREEhouse South, which opened in Mission Viejo in July 2017, TreeHouse North provides voluntary, short-term services, typically lasting 7 to 14 days. The team of peer counselors and licensed professionals provides co-occurring capable services for people who are experiencing a behavioral health crisis and may also have substance use issues.

Central California

In June, one of Telecare's oldest Stanislaus County programs expanded its services to join the Stanislaus CARE team, a multi-agency team providing services to people experiencing homelessness and co-occurring mental illness.

In July, Telecare's early intervention program serving San Joaquin County's youth expanded from 25 to 50 slots to meet the growing community needs. Telecare is pleased to support efforts to address mental health issues at the earliest stages to help people prevent or minimize the negative effects of untreated symptoms of mental illness.

Northern California

In July, Telecare's crisis walk-in clinic completed the redesign of its services to meet the evolving needs of their community by adding a medication clinic and case management. Over the years, Sausal Creek has served Alameda County as a 24/7 crisis walk-in.

In 2010, Telecare began a journey to Whole Person Care, bringing greater focus on healthcare and substance use services into our behavioral health programs.

With limited resources to draw upon, we needed to be cost-conscious and choose approaches that offered the greatest impact and leverage.

In April 2018, we shared our journey and lessons learned in an iPoster session at NatCon18.

View a PDF of the Presentation

Download our natcon iposter session by clicking the image above.

Workforce Development

As we began to develop our Whole Person Care plan, we found that we needed to address the training challenges of our geographically diverse and multidisciplinary workforce. Telecare has nearly 3,500 staff spread over seven states and a very diverse workforce of behavioral health providers and nursing staff. The entire range of our staff needed to understand the importance of whole health as well as have knowledge of co-occurring substance use and chronic health conditions, and be able to use tools to engage clients and enhance motivation through stage-matched conversations. To address this, we developed an 18-hour Whole Person Care eLearning program that covers stages of change, substance use and addiction education, as well as significant facts on chronic health conditions, culminating in an earned certificate.

Clinical Practice Improvement

We needed to update and enhance our current clinical practices to include whole health education and lifestyle modifications, as well as explore clinical models for coordinated care that improve outcomes and reduce costs for customers.

Our Co-Occurring Education Groups (COEG) were developed to reach people in pre-contemplation and contemplation stages of change around substance use. We also created “Smart Sets”: Decision trees that enforce key elements of health integration and identify touchpoints for motivational enhancement. We also partnered with customers to build new coordinated care clinical models that improve outcomes while reducing costs. We tested and refined new processes and then disseminate them broadly to the rest of our programs. Finally, we identified several interdependent evidence-based practices and developed a clinical framework to bring them to staff, matching the critical skills to staff roles and client acuity levels.

Client Education

Telecare Gresham Co-Occurring Education Group

Telecare's Whole Person Care Sample Curriculum

The people we serve often do not understand their high-risk physical health conditions, nor do they have fact-based information on the effects of substance use on their health. To assist our mental health providers in regularly educating and engaging clients in conversations around their health conditions, Telecare created easy-to-read, visually-engaging handouts that present a range of whole health topics, including blood pressure, body weight, diabetes, and asthma. The handouts provide education on facts and effects about each condition and offer suggestions for how to manage or prevent the condition. They also inform and empower clients by suggesting lifestyle changes that can directly improve their health and wellness.

Staff have reported increased confidence initiating conversations by using these handouts, and clients report that they are learning information about their conditions for the first time. We have translated these handouts into six threshold languages to increase accessibility. Our workforce benefits from the handouts as well: staff report that they are using the handouts to learn about and manage their own chronic health conditions.

Initial Outcomes

Telecare’s Partners in Wellness, the first mental health Pay for Success program in the nation that incorporates our Whole Health tools, is surpassing its success targets, with excess savings of more than $500,000 in the first year. Another program, Inland Empire Health Plan (IEHP), a population management program for high utilizers, has shown statistically significant reductions in psych inpatient, psych ER, medical ER, and IOP utilization, as well as increased contacts with their primary care physicians. (See poster for more details.)

Lessons Learned

We have learned that the following practices greatly enhance our ability to integrate Whole Person Health into our programs:

Educating our senior leadership team first. Senior leaders must fully understand and be "on board" with new practices and clinical models before roll-out to the company at large.

Engaging all staff to see health equity as a social justice issue, which helps us advocate for the people we serve.

Communicating clearly and consistently to ensure comprehension and buy-in from staff.

Adapting plans as funding appears and disappears; being nimble allows us to keep up with changes in the healthcare environment.

And finally, remembering that small steps matter! Sustaining momentum is important when introducing and learning from new models of care.

At NatCon2018, Telecare hosted a lunch and learn presentation sharing initial results from our PFS program, an overview of the PFS model, a clinical overview of the program, and learnings for other systems interested in possible implementation. We are pleased to share the presentation and findings below.

Alternative Payment Models:Pay for Success

Initial Results

In the first year of operation, Partners in Wellness saved more than $508,482 above the target savings. The program reduced usage well over the target rate for all services, including 81% over the target of psychiatric emergency services visits and 100% over the target for state hospital days. Significant clinical results were also shown: after a year, people with higher depression, psychosis, and drug and alcohol use scores showed significant improvement over time. Anxiety levels (measured through screenings) also improved, as well as physical health measurements such as HDL-C scores.

PFS Model Overview

Telecare's Partners in Wellness program is an innovative six-year, performance-based contract to deliver publicly-funded services. Telecare is at risk to deliver the savings targets outlined in the contract by reducing clients' use of psychiatric hospitals, psychiatric emergency services, state hospitals, and other mental health services while also ensuring each client’s whole-person wellness. The performance targets are set to fully pay for the program (in savings) and return additional savings at the end of the six years. Dr. Keith Humphreys of Stanford University objectively evaluates the program results. From the RFP process beginning in December 2014 through the January 2017 official launch of the program, more than two years of work went into the development of this program.

What's Different About Pay for Success?

Pay for Success programs, including Partners in Wellness, include several areas of additional measures and tools, and a higher degree of data analytics, than other programs typically provide. (Click on the chart to the right to see an outline of some of these differences.)

PFS Clinical Model Overview

The clinical care model for Partners in Wellness uses several tools to engage with consumers, also known as partners, on multiple fronts. Physical and mental health are measured through screenings and assessments, and a "whole health" care plan is created in partnership with the persons served. From there, the multidisciplinary team — including several peer specialists — works with the partner to ensure they have adequate housing, medications, physical health supports, care coordination, and assistance in developing recovery tools as they work toward their wellness and recovery goals. Data from health measures and a daily "Wellness Snapshot" are entered and used to produce a Huddle Report that prioritizes the team's treatment and intervention planning in their morning huddle. A monthly report tracks partners' progress over time. Treatments are adjusted as needs change.

Lessons Learned

One of the most important lessons we have learned in our first year of operations is how crucial it is to have a firm understanding of the community in which we are working, as well as strong relationships within that community. Factors such as other community resources, housing costs, and Conservator or Public Guardian Policies can all make a big difference in the outcomes of Pay for Success programs like Partners in Wellness.

Telecare is excited to attend National Council's NATCON2018 in Washington, D.C., April 23 - 25. We are presenting at two forums during the conference. Dr. Kent Eller, SVP and Chief Medical Officer, and Shannon Mong, Director of Innovation Initiatives, will be presenting a Whole Person Care poster session. Shannon will also be presenting a Pay for Success Model Lunch-n-Learn with Faith Richie, SVP of Development.

Join us for Breakfast

In addition to our regular booth, we will be hosting an informal breakfast at the Gaylord National Resort & Convention Center, Magnolia 2 Conference Room, on April 24.

RSVP

Let us know if you'd like to join us! Send your RSVP to Cynde Burgstahler at cburgstahler@telecarecorp.com.

NAMI also creates an excellent resource page with talking points, infographics, social media suggestions, and more. Check out the NAMI Mental Health Month resource page for more information.

The National Council for Behavioral Health created resources to make outreach efforts even easier. Download infographics on women's mental health, how to help a friend in need, and identifying behaviors in teens that might be warning signs. Check out their resource page here.

Across the pond, Princess Kate launches Mentally Healthy Schools, a program that will provide free mental health resources for school teachers and school staff in the UK so that they can better detect and help students experiencing mental health challenges.

Telecare has made recent improvements to our operational structure to provide better leadership for our programs and better service to our customers. To read more about our leadership changes, click here.

This month, we are pleased to introduce our newest Vice President of Operations, Michael Sherbun, as well as welcome our other newest leadership staff below!

Michael Sherbun, VP of Operations

Michael Sherbun, Vice President of Operations at Telecare

"I am passionate about this field and assuring treatment is available for all those who are in need," said Michael. "I look forward to continuing the rich culture that Telecare has created and expanding our service wherever needed to enhance access to mental health treatment.I truly love what I do, and am fortunate to be with a company as great as Telecare."

As Telecare works to ensure a strong workforce for the future, we also want to make sure there is a big enough pool of qualified leaders to meet our organizational needs. To support this, we introduced an Emerging Leaders Program, a skills-building curriculum for existing Telecare employees who are committed to developing themselves as leaders.

"We set up this training in an attempt to grow our own leadership within the organization," said Suzanne Rudnitzki, Senior Vice President of Human Resources at Telecare. "How nice would it be early in your career if someone reached out and said, 'You know, I think you really have potential, maybe I can help you get the leadership skills to take you to the next level.'"

Fifty employees applied for the twenty-five-slot program, which began in January and will run through October. The program consists of 10 full-day trainings and kicked off with a presentation from Telecare’s President and CEO, Anne Bakar.

Over the course of the program, future leaders will be educated in cutting-edge tools and research on management and leadership presented by experienced facilitators, as well as new approaches and skills to foster impact, effectiveness, collaboration, and sustained commitment. The program will conclude with a project aimed at improving Telecare that the cohort will present to senior leadership, including Anne.

"At the end of our program, these emerging leaders will have to make choices. Would they like to apply for a leadership position? What would they like to do with the tools they’ve just been taught?" said Suzanne. "We'll help them leverage their learning and get connections with corporate leaders and resources to help them excel in their career here, with the added benefit of their deep knowledge of the organization."

We will check in with our emerging leaders when the program concludes. In the meantime, to learn more about what Telecare is doing to develop a strong workforce, click here.

Last month, we introduced our Workforce Development Plan and how Telecare will use this blueprint to strengthen our organization and hire more than 2,200 qualified individuals by 2020 to staff our new and existing programs. We shared key actions we are currently taking as a result of our workforce research, including advocating for Peer Certification in California, which coincides with our company-wide goal of having two full-time peer staff at every program by the year 2020.

This month, we share some specific things we are doing internally at Telecare to build a better workforce for the future!

Onboarding

At Telecare, we want our employees to stay with us for the long-term. Our data shows that if an employee stays with Telecare past six months, it is more likely that they will stay at Telecare for five years or longer. One of the key factors in determining whether a new employee will stay with the company beyond the six-month mark is their onboarding experience.Those first few days with Telecare are so critical in terms of communicating our culture, our history, and the essence of the important work that we do with the people we serve. To this end, we created and launched a new and improved New Hire Orientation.

Suzanne Rudnitzki, Co-author of the workforce development plan and Telecare's Senior Vice President of Human resources

Shelagh little, Co-author of the workforce development plan and Telecare's director of business development

In this process, the first two days of every new hire's experience at Telecare are spent with a range of leaders and facilitators who educate new staff on our history, scope, mission, culture, and our recovery philosophy, as well as all the required information they need to be successful in their career at Telecare. We use activities that fully engage the new hires in learning, building connections, and gaining a consistent foundation of knowledge as they begin at Telecare. The feedback since launching this new orientation has been extremely positive, and we look forward to developing this further as we continually improve the onboarding process.

Hiring

We are looking at creative ways to interview and hire as we expand into more geographically diverse areas. For example, we are implementing video interviewing as a way to increase efficiency in some locations, as well as making it more convenient for potential new hires to apply to Telecare.

In addition, we are exploring ideas such as relocation assistance and sign-on bonuses for leadership roles in our more rural or harder-to-serve areas. Our hope is that this will encourage great people to join Telecare in areas that are traditionally more difficult to staff, where they can grow their careers, wherever their career paths may take them. Our hope is that they stay and grow with Telecare!

Specialized Learning and Coaching

As we look to the future and envision the leadership we will need, we are strongly aware that many of our best leaders emerge from existing staff. The leaders who have grown within Telecare become our best culture carriers and our strongest advocates. To support this growth, we have implemented several new tools for developing leadership within Telecare.

We have a passion for investing in our leaders. The goal of the Emerging Leaders Program is to empower, elevate, and connect the next generation of leaders within Telecare. Emerging Leaders is a 10-month (one full day each month) program that assembles a select cohort of emerging leaders and guides them through a rigorous, relevant, and applied curriculum. Our first Emerging Leaders Program is currently in session, and initial feedback has been positive.

Our Leadership Success Series for hiring managers provides essential Human Resources training as well as key problem-solving techniques, management coaching, and additional tips for being an excellent leader.

We recently restructured our regional leadership roles, localizing program oversight on a regional basis, and elevating key leadership staff to roles in geographic regions with which they are already familiar with. This has created better customer relations, deeper connections with local care systems, and opportunities for staff to grow.

We believe in the potential of our staff to grow within Telecare, developing into leaders who attract like-minded people who want to join Telecare and contribute to the amazing work that happens here every day, now and into the future.

By 2025, the behavioral healthcare field will face moderate to severe workforce shortages in nearly every sector. Telecare Corporation alone will need to hire nearly 2,200 qualified individuals by 2020 in order to staff our new and existing programs. To address this shortage and to plan for our future staffing needs, Telecare has created a Workforce Development Plan.

A Workforce Development Plan is a snapshot that captures the current metrics of the organization: the number of employees, certain demographics, what types of jobs are currently available, vacancy rates, turnover rates, and more. The organization then looks at how its products and services are likely to change in the future, and uses this knowledge in tandem with the metrics to develop a plan to build its workforce for the future.

One of the reasons this plan is so important at Telecare is that our “product” is excellent care for people with complex mental health and physical health needs. Our workforce, especially front-line staff and local leaders, are the ones who deliver this care. Having a stable and high-performing workforce is absolutely essential at our organization. It is one of our primary goals and measures of quality.

Another important reason Telecare undertook this workforce planning effort was to more clearly see the areas where we, as a company and as an industry, may have gaps that we must actively work to address. Two gap areas that we uncovered were in the areas of peer positions and licensed professionals.

For example, as we refined our “Two by 2020” goal, which is to have two peer positions (at minimum) on staff at every Telecare location by 2020, we noticed that in California the standardization of peer training and peer qualifications is not robust. As a result, we have begun to advocate for standardized training for peer positions, which will help Telecare to hire well-prepared peer staff, and could also help the overall field in California by establishing more widely recognized criteria for those roles and by providing a clearer path for individuals to advance their careers.

An additional example is the need for licensed professionals. In creating our plan at Telecare, we have included ways to maximize our ability to attract the outstanding professionals that are already in the field, as well as ways to build bridges between learning institutions and our workplace. One of our strategies we are implementing will be to centralize and coordinate our intern function in the organization, so that we have a pipeline of new graduates that could be successful, and stay and build their career at Telecare.

Key Findings for Telecare’s Workforce Development

A number of key findings emerged during the process of creating a Workforce Development Plan specifically for Telecare.

1. We must be creative to hire nearly 2,200 employees by 2020.

With a clear goal in mind and a clear understanding of our current recruiting processes, we recognized the need to go beyond the standard process of recruiting by using new and creative tactics to attract and keep these 2,200 new employees. We have already tapped into our existing leadership workforce and have developed a host of unique strategies that will broaden our reach and visibility with potential new staff.

2. We need to maintain staff diversity as we serve increasingly diverse communities.The second key finding recognized that we are a richly diverse company and this diversity is one of Telecare’s most important assets. We are diverse not only in terms of ethnicity and language, but also age, and this adds to the deep culture of Telecare. As the clients and communities we serve also become more diverse, our workforce will need to mirror that trend.

3. We are a passionate group of people who thrive with a strong mission and culture.The third key finding was the extent to which our employees—both current and former—positively regard their experience at Telecare and strongly relate to our mission and our culture. They love their teams and coworkers. Our task then becomes the way in which we leverage that positive regard and continue this trend for future employees. One way we are achieving this is through our revamped New Hire Orientation, which welcomes new employees into our culture on day one and follows them through their first few months on the job as they acclimate and become a part of their new team.

Next Month

Next month, we will take a deeper look at what we are doing more specifically at Telecare to build a better workforce for the future!

Telecare has recently made improvements to our operational structure to provide better leadership over our programs and better service to our customers.

In short, we created a structure that is more regionally-focused. This is a change from our previous structure which was product type-focused.

In our new structure, the programs within a specific region will be generally covered by a designated leader, regardless of product type. This will enable leaders to take a more holistic approach to meeting the needs of a region, including workforce requirements, clinical oversight, community engagement, and customer service.

The only exceptions to the new regional structure will be for Skilled Nursing Facilities (SNFs), Joint Commission acute programs, and DD/MI programs. Each of these program types will be overseen by a VP or Regional Director with deep knowledge in these programs, licensing requirements, etc.

As part of our process, we promoted three leaders into new roles at Telecare. We are pleased to recognize and introduce those leaders here.

Mary Thrower, Vice President of Operations at Telecare

Mary Thrower, VP of Operations

"I look forward to working with our county customers, helping to identify and find solutions for unmet service needs, ensuring that strong partnerships are developed and maintained, and strengthening the quality of services provided at each level of care," said Mary. "This new role will allow me to stretch beyond the counties and service lines I've worked with as Regional Director of Operations for Telecare and apply my twenty-plus years of operations experience to an even broader base."

Mary will oversee two of Telecare's regional directors who cover fifteen of our Northern California programs in nine counties. In addition to Shannan Taylor's programs below, Mary will oversee programs which report up through Asha George, Regional Director of Operations. These programs include TMRS, TRAC, Placer County PHF, Stanislaus PHF, El Dorado PHF, and Stanislaus CSU.

Shannan taylor, regional director of operations at Telecare

Shannan Taylor, Regional Director of Operations

"I have a passion for finding innovative ways to improve the delivery of mental health services to those most in need," said Shannan. "This position allows me to do more of what I love, spanning across a variety of program types and counties."

Steven Oppenheimer, Regional Director of Operations

“I see this as an opportunity to grow our service lines within Riverside County,” said Steven. “I am excited about partnering with the county to establish a strong foothold for expansion and growth. Our current product lines within Riverside County are diverse, and I feel like there is additional room for new and innovative programs and services.”